Abstract
<title>Abstract</title> <p> Purpose To describe the epidemiology of pediatric community-onset severe bacterial infections (COSBIs) in France between 2015 and 2018 and evaluate changes over the 2010–2020 decade. Methods We conducted a prospective, observational study in 12 French pediatric intensive care units (PICUs) between 2015 and 2018, including children younger than 18 years admitted with a COSBI. Clinical characteristics, microbiological findings, and outcomes were reported. Age-standardized incidence, disability, and mortality rates were estimated in three administrative divisions of western France and compared with those from a 2009–2014 study. Results Among 493 children included, the median age (interquartile range [IQR]) was 2.1 (0.4–6.8) years, and 21% had underlying comorbidities. The most frequently identified pathogens were <italic>Neisseria meningitidis</italic> (19%) and <italic>Streptococcus pneumoniae</italic> (19%). Overall in-hospital mortality was 5.3% (95% CI, 3.6–7.8), and 15.8% (95% CI, 12.6–19.5) of survivors had moderate-to-severe disability at PICU discharge. The age-standardized incidence of COSBIs increased from 3.0 (95% CI, 2.7–3.2) to 4.8 (95% CI, 3.8–5.7) per 100,000 child-years between 2009–2014 and 2015–2018 (rate difference, 1.8; 95% CI, 0.8 to 2.8), corresponding to a 60% relative increase. Mortality remained unchanged, whereas the rate of moderate-to-severe disability increased by 270% (rate difference, 0.8; 95% CI 0.3 to 1.2). Conclusion The incidence of pediatric COSBIs increased in western France during the 2010–2020 decade, before the implementation of mandatory childhood vaccination. The marked increase in disability among survivors highlights the need for continued epidemiological surveillance and research into the long-term consequences of pediatric severe bacterial infections. </p>